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A diagnosis of ADHD can be made by a general practitioner without a comprehensive assessment.
A diagnosis of ADHD can be made by a general practitioner without a comprehensive assessment.
False
Drug treatments are the primary treatment plan for ADHD.
Drug treatments are the primary treatment plan for ADHD.
False
Methylphenidate is a central nervous system (CNS) depressant.
Methylphenidate is a central nervous system (CNS) depressant.
False
Dexamfetamine has a larger evidence base from trials compared to methylphenidate.
Dexamfetamine has a larger evidence base from trials compared to methylphenidate.
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Lisdexamfetamine is not a prodrug.
Lisdexamfetamine is not a prodrug.
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Methylphenidate and dexamfetamine are Schedule 1 Controlled Drugs.
Methylphenidate and dexamfetamine are Schedule 1 Controlled Drugs.
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Prescriptions for methylphenidate and dexamfetamine should be written for a maximum supply of 60 days.
Prescriptions for methylphenidate and dexamfetamine should be written for a maximum supply of 60 days.
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Dexamfetamine is less likely to be diverted and misused compared to methylphenidate.
Dexamfetamine is less likely to be diverted and misused compared to methylphenidate.
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Lisdexamfetamine is broken down in the liver.
Lisdexamfetamine is broken down in the liver.
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Lisdexamfetamine has a higher abuse potential compared to methylphenidate.
Lisdexamfetamine has a higher abuse potential compared to methylphenidate.
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Atomoxetine is more effective than stimulants in treating ADHD.
Atomoxetine is more effective than stimulants in treating ADHD.
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Lisdexamfetamine has been established as superior to placebo in children and adolescents.
Lisdexamfetamine has been established as superior to placebo in children and adolescents.
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Bupropion has not been found to be efficacious in treating ADHD.
Bupropion has not been found to be efficacious in treating ADHD.
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Guanfacine is not licensed for use in children with ADHD in the UK.
Guanfacine is not licensed for use in children with ADHD in the UK.
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Tricyclic antidepressants are recommended for use in clinical practice.
Tricyclic antidepressants are recommended for use in clinical practice.
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Modafinil has been found to be effective in adults with ADHD.
Modafinil has been found to be effective in adults with ADHD.
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Second-generation antipsychotics are recommended for treating ADHD.
Second-generation antipsychotics are recommended for treating ADHD.
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ADHD first diagnosed in adult life is not compatible with ICD-11 and DSM-5.
ADHD first diagnosed in adult life is not compatible with ICD-11 and DSM-5.
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Methylphenidate is considered a second-line choice of medication in adults with ADHD.
Methylphenidate is considered a second-line choice of medication in adults with ADHD.
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Dexamfetamine is not used to treat ADHD in adults whose symptoms are responding to lisdexamfetamine.
Dexamfetamine is not used to treat ADHD in adults whose symptoms are responding to lisdexamfetamine.
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The dosage of guanfacine for children weighing 6-12 kg is initially set at 1mg once daily.
The dosage of guanfacine for children weighing 6-12 kg is initially set at 1mg once daily.
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The maximum per dose of guanfacine for adolescents weighing 58.5 kg and above is 6mg.
The maximum per dose of guanfacine for adolescents weighing 58.5 kg and above is 6mg.
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For adolescents aged 13-17 weighing between 41.5-49.4 kg, the maximum per dose of guanfacine is 5mg.
For adolescents aged 13-17 weighing between 41.5-49.4 kg, the maximum per dose of guanfacine is 5mg.
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Initially, guanfacine should be administered at 1mg once daily for all weight categories listed.
Initially, guanfacine should be administered at 1mg once daily for all weight categories listed.
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For a 7-year-old child weighing 10 kg, the maintenance dose of guanfacine would range from 0.5-1.2mg/kg once daily.
For a 7-year-old child weighing 10 kg, the maintenance dose of guanfacine would range from 0.5-1.2mg/kg once daily.
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Guanfacine dosages should be adjusted in steps of 1mg every two weeks.
Guanfacine dosages should be adjusted in steps of 1mg every two weeks.
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For adolescents aged 13-17 weighing between 49.5-58.4 kg, the maximum per dose of guanfacine is 6mg.
For adolescents aged 13-17 weighing between 49.5-58.4 kg, the maximum per dose of guanfacine is 6mg.
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Guanfacine is not available for children weighing less than 6 kg.
Guanfacine is not available for children weighing less than 6 kg.
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For children weighing 13-17 kg, the initial dosage of guanfacine is 2mg once daily.
For children weighing 13-17 kg, the initial dosage of guanfacine is 2mg once daily.
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The maintenance dose of guanfacine for all weight categories listed should range between 0.05-0.12mg/kg once daily.
The maintenance dose of guanfacine for all weight categories listed should range between 0.05-0.12mg/kg once daily.
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Children under 5 years should be given medication for ADHD without a need for a second specialist opinion.
Children under 5 years should be given medication for ADHD without a need for a second specialist opinion.
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Environmental modifications should not be implemented for children with ADHD.
Environmental modifications should not be implemented for children with ADHD.
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Methylphenidate is considered the first-choice medication for the treatment of ADHD.
Methylphenidate is considered the first-choice medication for the treatment of ADHD.
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An electrocardiogram (ECG) is always required before starting stimulants for ADHD.
An electrocardiogram (ECG) is always required before starting stimulants for ADHD.
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Atomoxetine and guanfacine can be offered to children aged 5 years and over whose symptoms did not respond to methylphenidate or lisdexamfetamine.
Atomoxetine and guanfacine can be offered to children aged 5 years and over whose symptoms did not respond to methylphenidate or lisdexamfetamine.
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Height and weight monitoring is not necessary for children with ADHD on medication.
Height and weight monitoring is not necessary for children with ADHD on medication.
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If ADHD symptoms persist despite environmental modifications, medication should be offered after a baseline assessment.
If ADHD symptoms persist despite environmental modifications, medication should be offered after a baseline assessment.
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Lisdexamfetamine should not be considered for children who did not benefit from a 6-week trial of methylphenidate.
Lisdexamfetamine should not be considered for children who did not benefit from a 6-week trial of methylphenidate.
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A cardiology opinion should be sought if a child with ADHD has a history of sudden death in a first-degree relative under 40 years.
A cardiology opinion should be sought if a child with ADHD has a history of sudden death in a first-degree relative under 40 years.
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Dexamphetamine should be considered for children whose ADHD symptoms are responding to lisdexamfetamine but who cannot tolerate its longer effect profile.
Dexamphetamine should be considered for children whose ADHD symptoms are responding to lisdexamfetamine but who cannot tolerate its longer effect profile.
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The onset of action for methylphenidate immediate release is between 20 and 60 minutes.
The onset of action for methylphenidate immediate release is between 20 and 60 minutes.
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Methylphenidate modified release has an initial daily dose of 35mg in the morning.
Methylphenidate modified release has an initial daily dose of 35mg in the morning.
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Concerta XL consists of an immediate-release component that makes up 22% of the dose and a modified-release component making up 78%.
Concerta XL consists of an immediate-release component that makes up 22% of the dose and a modified-release component making up 78%.
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An afternoon dose of methylphenidate immediate release is forbidden for children using modified-release methylphenidate.
An afternoon dose of methylphenidate immediate release is forbidden for children using modified-release methylphenidate.
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Equasym XL has an onset of action between 30 and 90 minutes.
Equasym XL has an onset of action between 30 and 90 minutes.
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The licensed maximum dose of methylphenidate modified release is 54mg daily.
The licensed maximum dose of methylphenidate modified release is 54mg daily.
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Concerta XL has an initial dose of 20mg in the morning.
Concerta XL has an initial dose of 20mg in the morning.
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Medikinet XL consists of an immediate-release component that constitutes 50% of the dose.
Medikinet XL consists of an immediate-release component that constitutes 50% of the dose.
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For methylphenidate, dexamfetamine, and lisdexamfetamine, it is important to monitor blood pressure, pulse, height, and weight.
For methylphenidate, dexamfetamine, and lisdexamfetamine, it is important to monitor blood pressure, pulse, height, and weight.
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Bioequivalent versions of Concerta XL include Matoride XL, Xenidate XL, and Delmosart modified release.
Bioequivalent versions of Concerta XL include Matoride XL, Xenidate XL, and Delmosart modified release.
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Ritalin XL consists of an immediate-release component and a sustained-release component.
Ritalin XL consists of an immediate-release component and a sustained-release component.
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Dexamfetamine immediate release has an onset of action that ranges from 20-60 minutes.
Dexamfetamine immediate release has an onset of action that ranges from 20-60 minutes.
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The initial dosing recommendation for Lisdexamfetamine is between 30 and 40mg in the morning.
The initial dosing recommendation for Lisdexamfetamine is between 30 and 40mg in the morning.
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Atomoxetine is classified as a noradrenaline reuptake inhibitor.
Atomoxetine is classified as a noradrenaline reuptake inhibitor.
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For children weighing less than 70kg, the recommended maintenance dose of Atomoxetine is 80mg daily.
For children weighing less than 70kg, the recommended maintenance dose of Atomoxetine is 80mg daily.
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Lisdexamfetamine is a prodrug that gradually hydrolyses to dexamfetamine.
Lisdexamfetamine is a prodrug that gradually hydrolyses to dexamfetamine.
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Atomoxetine is more effective than stimulants for treating ADHD.
Atomoxetine is more effective than stimulants for treating ADHD.
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The maximum daily dose of Dexamfetamine is 20mg daily.
The maximum daily dose of Dexamfetamine is 20mg daily.
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Ritalin XL has an onset of 30 minutes and a duration of up to 6 hours.
Ritalin XL has an onset of 30 minutes and a duration of up to 6 hours.
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When switching from a stimulant to Atomoxetine, the stimulant should be continued for the first 4 weeks of Atomoxetine therapy.
When switching from a stimulant to Atomoxetine, the stimulant should be continued for the first 4 weeks of Atomoxetine therapy.
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Study Notes
Diagnosis and Treatment of ADHD in Children
- A comprehensive assessment by a specialist is necessary to diagnose ADHD in children.
- A combination of psychological, psychosocial, and behavioral interventions should be used in treatment, with medication only used when necessary.
Medications for ADHD in Children
- Methylphenidate is the first-line treatment for ADHD in children when medication is required.
- Common adverse effects of methylphenidate include insomnia, appetite suppression, raised blood pressure, and growth deceleration.
- Dexamfetamine is an alternative CNS stimulant, but has less evidence on efficacy and safety than methylphenidate.
- Lisdexamfetamine is a prodrug that is gradually broken down in red blood cells, making it unlikely to be abused.
- Atomoxetine is a non-stimulant alternative that may be useful for children who do not respond to stimulants or have adverse effects.
Other Medications for ADHD in Children
- Alpha-2 agonists (clonidine and guanfacine) can be used as alternative non-stimulant medications.
- Bupropion seems to be efficacious and well-tolerated for ADHD in children.
- Modafinil has useful activity in children with ADHD, but not in adults.
- Tricyclic antidepressants may be effective, but are not recommended in clinical practice.
ADHD in Adults
- ADHD first diagnosed in adult life is compatible with ICD-11 and DSM-5.
- Medication is the first line of treatment for ADHD in adults, with the same principles as for children.
- Around 65% of patients with ADHD continue to meet full criteria or have achieved only partial remission by adulthood.
- A comprehensive assessment is necessary to diagnose ADHD in adults, including information from other informants and from adults who knew the patient as a child.
Medications for ADHD in Adults
- Methylphenidate, lisdexamfetamine, and atomoxetine are licensed for first-time use in adults with ADHD.
- Dexamfetamine can be used for adults whose ADHD symptoms are responding to lisdexamfetamine but who cannot tolerate the longer effect profile.
- Monitoring for symptoms of liver dysfunction and suicidal thinking is necessary for atomoxetine use in adults.
Guanfacine Dosage
- Initially, 1mg once daily for children weighing 6-12 kg, adjusted in steps of 1mg weekly.
- Maintenance dose: 0.05-0.12mg/kg once daily, with a maximum dose of 4mg.
- For children weighing 13-17 kg, initially 1mg once daily, adjusted in steps of 1mg weekly.
- Maintenance dose: 0.05-0.12mg/kg once daily, with a maximum dose of 4-7mg depending on weight.
Medication Onset and Duration
- Ritalin XL: onset 60 minutes, duration 8-12 hours.
- Dexamfetamine immediate release: onset 20-60 minutes, duration 3-6 hours.
- Lisdexamfetamine (Elvanse): onset 20-60 minutes, duration 13+ hours.
- Atomoxetine: onset approximately 4-6 weeks.
NICE Guidance for ADHD in Children
- Drug treatment for ADHD should be initiated by a specialist and only after a comprehensive assessment of mental and physical health, and social influences.
- Children under 5 years old should not be given medication unless they have a second specialist opinion from an ADHD service specializing in young children.
- There must be a group parent-training programme in place for all children under 5 years with ADHD.
- Environmental modifications should be implemented for all children with ADHD.
- Medication should be offered if there is a persistent significant impairment in a domain despite modifications, following a baseline assessment.
Medications for ADHD
- Methylphenidate (first-choice medication): onset 20-60 minutes, duration variable.
- Lisdexamfetamine: consider switching to this medication for children aged 5 years and over who have had a 6-week trial of methylphenidate at an adequate dose but have not derived enough benefit.
- Dexamfetamine: consider for children aged 5 years and older, and young people whose ADHD symptoms are responding to lisdexamfetamine but who cannot tolerate the longer effect profile.
- Atomoxetine or guanfacine: offer to children aged 5 years and over, and young people that cannot tolerate methylphenidate or lisdexamfetamine, or whose symptoms were not responsive to a 6-week trial.
Monitoring and Prescribing
- Monitoring should include measurement of height and weight, recording of blood pressure, and heart rate.
- An electrocardiogram (ECG) is not needed before starting stimulants, atomoxetine, or guanfacine, unless the person has any specific cardiac conditions or risks.
- A cardiology opinion should be sought if any of the above apply.
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Description
Learn about the diagnosis and treatment of ADHD in children, including the importance of comprehensive assessment and combined interventions.
